Objective: Antipsychotic-related prolactin changes may expose children and adolescents to severe adverse reactions (ARs) related to pubertal development and growth. We therefore aimed to assess the effects of antipsychotics on prolactin levels and associated somatic ARs in children and adolescents. Methods: We systematically searched PubMed and CENTRAL for placebo-controlled randomized trials of antipsychotics in children and adolescents aged ≤18 years, reporting prolactin levels and related ARs. We conducted a random-effect meta-analysis and assessed risk of bias version 2 (ROB2). Results: Thirty-two randomized controlled trials with an average trial duration of 6 weeks, covering 4643 participants with an average age of 13 years and a male majority of 65.3%. Risk of bias across domains was low or unclear. The following antipsychotic compounds: aripiprazole (n = 810), asenapine (n = 506), lurasidone (n = 314), olanzapine (n = 179), paliperidone (n = 149), quetiapine (n = 381), risperidone (n = 609), and ziprasidone (n = 16) were compared with placebo (n = 1658). Compared with placebo, statistically significant higher prolactin increase occurred with risperidone (mean difference [MD] = 28.24 ng/mL), paliperidone (20.98 ng/mL), and olanzapine (11.34 ng/mL). Aripiprazole significantly decreased prolactin (MD = -4.91 ng/mL), whereas quetiapine, lurasidone, and asenapine were not associated with significantly different prolactin levels than placebo. Our results on ziprasidone are based on a single study, making it insufficient to draw strong conclusions. On average, 20.8% of patients treated with antipsychotic developed levels of prolactin that were too high (hyperprolactinemia), whereas only 1.03% of patients reported prolactin-related ARs. Data were highly limited for long-term effects. Conclusions: In children and adolescents, risperidone, paliperidone, and olanzapine are associated with significant prolactin increase, whereas aripiprazole is associated with significant decrease. Despite the significant changes in prolactin level, few ARs were reported. Study protocol on PROSPERO: CRD42018116451.

Objective: To evaluate the relationship between self-reported and performance-based measures of functioning in rheumatoid arthritis (RA), knee osteoarthritis (OA), and fibromyalgia (FM), and the influence of pain and fatigue. Method: Self-reported functioning was assessed by the Stanford Health Assessment Questionnaire, Fibromyalgia Impact Questionnaire, and Knee injury and Osteoarthritis Outcome Score. Performance-based measures of task-related physical activity included grip strength and Six-Minute Walk Test (6MWT). Assessment of Motor and Process Skills (AMPS) was used to obtain performance-based measures of activities of daily living (ADL) ability. Pain and fatigue were assessed by 100 mm visual analogue scales. Spearman’s rho correlation and regression modelling were applied. Results: Correlations between self-reported functioning and performance-based measures of ADL ability were weak to moderate, and strongest in OA (r = 0.57, p = 0.002), and AMPS ADL ability measures did not enter regression models as explanatory factors for self-reported functioning. Correlations between AMPS ADL ability measures and measures of task-related physical activity were weak, except for a strong correlation between AMPS ADL motor ability and 6MWT in OA (r = 0.63, p = 0.000). The 6MWT was the only performance-based test explaining variance in AMPS motor ability (OA = 42%; FM = 11%). Pain explained variance in self-reported ability and contributed to variance in AMPS ADL motor ability measures in OA. Conclusion: Self-reported and observed measures of functioning assess partly different aspects of functioning, and both approaches may therefore be relevant in a structured assessment of patients with musculoskeletal disorders.

The aim of this community-randomised smoking cessation (SC) trial was to investigate both recruitment and SC-rates in three municipalities offering financial incentives (FIM) to smokers who stop smoking when attending a municipal SC-program and compare these with three municipalities investing in a campaign (CAM) that should encourage smokers to use the SC-program. Furthermore, in a non-randomised matched control design we investigated whether there was a difference in recruitment and SC-rates in the three FIM and the three CAM, comparing each with three matched control municipalities (MCM). Each municipality received approx. $16,000. The FIM rewarded persons who were abstinent when attending the municipal SC-program. The CAM spent the money on a campaign recruiting smokers to the SC-program. Two of three FIM were only partly active in recruiting smokers in the intervention year 2018. An intention-to-treat (ITT) approach was used in analyses. Complete case analyses and multiple imputation were used to address loss to follow-up. No difference in recruitment was found between the CAM and the FIM (p = 0.954), in adjusted analyses. In ITT analyses, FIM achieved significantly higher odds of validated abstinence from smoking at one-year follow-up (OR (95%CI): 1.63(1.1-2.4)), but not of self-reported continuous abstinence after six months than CAM. Compared with no intervention, campaigns increased the recruitment of smokers to the SC-program while financial incentives increased six months abstinence rates. In a randomised trial, no difference was demonstrated in the effect of financial incentives and campaigns to recruit smokers to a SC-program and financial incentives seemed superior to help smokers staying smoke-free for a year. TRIAL REGISTRATION: ClinicalTrials.Gov ID: NCT03849092.

OBJECTIVES: A few previous studies have described a potential role of Ω-3 long-chain polyunsaturated fatty acids from marine animals in obesity in children, but the results are conflicting. The objectives of this study were to examine if intake of marine fat was related to less gain in body mass index (BMI) and body fat (BF) over a 15-mo period among Danish children age 2 to 6 y, and if potential associations depended on which types of fatty acids were replaced.

METHODS: A total of 355 children age 2 to 6 y were included in the study. Weight, height, and BF percentage (BF%) assessed by bioimpedance were measured by trained research personnel. Multivariable linear regression models were used to investigate associations between marine fat intake and changes in BMI or BF% over the subsequent 15 mo. To investigate substitution effects, we constructed regression models that included marine fat and all other energy yielding dietary components, except for the nutrient to be substituted for either all fats or specific subgroups (saturated, monounsaturated, or other polyunsaturated fatty acids).

RESULTS: No significant associations were observed between intake of marine fat and development in BMI or BF% in any of the analyses, either with or without specified substitutions. Furthermore, the results were independent on whether intake was expressed in g/d or percentage of energy, and were not modified by age or BMI status.

CONCLUSIONS: This study suggests that marine fat intake and fat composition in a diet may have little or no effect on weight and adiposity development among preschool-aged children.

Worldwide, colorectal cancer is the second most common cancer and third cause of cancer death in women. Estrogen exposure has been inversely associated with colorectal cancer. Oophorectomy reduces circulating estrogen, but the effect on colorectal cancer remains uncertain. The aim of this study was to examine the association between unilateral and bilateral oophorectomy and subsequent risk of colorectal cancer, and whether this association varied by menopausal status at time of oophorectomy, use of hormone replacement therapy (HRT) at baseline, hysterectomy and baseline body mass index (BMI). The study included 25 698 female nurses (aged ≥45 years) participating in the Danish Nurse Cohort. Nurses were followed from baseline until date of colorectal cancer, death, emigration or end of follow-up at December 31, 2018, whichever came first. We examined the association between oophorectomy and colorectal cancer (all ages and stratified by menopausal status). The potential modifying effects of hysterectomy, HRT use at baseline and BMI were investigated. During 542 140 person-years of follow-up, 863 (3.4%) nurses were diagnosed with colorectal cancer. Bilateral oophorectomy was associated with a 79% increased colorectal cancer rate, adjusted rate ratio (aRR) (95% confidence interval [CI]): 1.79 (1.33-2.42). Effect estimates following unilateral oophorectomy also showed higher rate of colorectal cancer, although less pronounced and nonstatistically significant (aRR) (95% CI): 1.25 (0.86-1.82). Similar results were seen when stratifying by menopausal status. The association was not modified by baseline HRT use, hysterectomy or BMI. Oophorectomy was associated with increased rate of colorectal cancer, with highest rates among women with bilateral oophorectomy.

Physical activity and obesity are known to be associated. We investigated whether a change in leisure time physical activities (LTPA) predicts a subsequent weight change, or vice versa. We used data from a longitudinal study among Danish adults surveyed in 1983–1984, 1987–1988, and 1993–1994. Between two sequential surveys, the change in LTPA was grouped as no change, became less or more active; the change in body weight was defined as no change, lost or gained of more than one body mass index (BMI) unit. Among 2386 adults, change in LTPA was not associated with subsequent weight change. However, a loss in body weight (BMI change < −1 unit) was associated with subsequent either becoming less [OR = 1.49, 95% CI (1.03–2.15)] or borderline more active [OR = 1.37, 95% CI (0.99–1.90)]. Subgroup analyses showed particularity among females that a loss in body weight was associated with subsequent becoming more active [OR = 1.83, 95% CI (1.15–2.89)]. Our results suggest that change in LTPA is unrelated to subsequent weight change, but loss in body weight seems related to subsequent more active among female adults.

BACKGROUND: The treatments for trochanteric fractures try to regain early mobility and limit morbidity and risk of reoperations. The most currently used dynamic hip screw (DHS) and the proximal femoral nail (PFN) are both with pros and cons. We aimed to assess the comparative effectiveness of these interventions for trochanteric fractures by evaluating the surgical performance and postoperative outcomes.

METHODS: PubMed, Web of Science and Cochrane Central Register were searched for RCTs comparing DHS and PFN for trochanteric fractures. All selected studies and the risk of bias were assessed. Clinical data including operative time, intraoperative blood loss, intraoperative fluoroscopy time, successful closed reduction and complications like nonunion, implant failure and reoperation were recorded. Random-effects models were used in Review Manager software, and GRADE was applied for the interpretation of the evidence.

RESULTS: From 286 identified trials, twelve RCTs including 1889 patients were eligible for inclusion; six RCTs directly comparing DHS with PFN, while other six compared DHS with proximal femoral nail antirotation (PFNA). Compared to DHS, PFN had shorter operative time and led to less intraoperative blood loss. However, DHS need less intraoperative fluoroscopy time than PFN. No difference was seen for the achievement of closed reduction. For risk of postoperative complications, no difference was seen between PFN and DHS for non-union, risk of implant failure and revision surgery.

CONCLUSIONS: PFN(A) resulted in a shorter operative time and less intraoperative blood loss compared to DHS. However, no difference was seen for postoperative complications. Trial registration PROSPERO: CRD42021239974.

INTRODUCTION: Frailty is a clinical syndrome that arises due to age-related decline, diseases, malnutrition and lifestyle. Two major perspectives on frailty exists: frailty as a phenotype and frailty as an accumulation of deficits. The two types are measured by Fried's Phenotype (FP) and the Clinical Frailty Scale (CFS), respectively. The aim of this study was to investigate which model best predicts 90-day mortality in elderly patients acutely admitted to an emergency department in Denmark.

METHODS: This study comprised a prospective cohort with the following inclusion criteria: age > 65 years, acute admission and admission >24 h. Bispebjerg Hospital, Odense University Hospital and Hospital of Southwest Jutland participated in the study. The FP and the CFS were measured in all patients. Descriptive statistics, relative risk (RR), odds ratio (OR), risk difference and receiver-operating characteristics (ROC) analysis were performed. The outcome was 90-day mortality.

RESULTS: A total of 1,030 patients participated (mean age: 78.2 years, 54% female). Among these, 221 were frail by the FP (score > 3) and 555 participants were frail by the CFS (score > 5). Within 90 days, 128 died. The analyses revealed significant associations between frailty and 90-day mortality. For the FP, the RR was 2.67 (95% confidence interval (CI): 1.93-3.69), p less-than 0.001; and for the CFS, the RR was 4.12 (95% CI: 2.65-6.42), p less-than 0.001. The adjusted OR for the CFS was 4.38 (95% CI: 2.68-7.13); for the FP, 3.88 (95% CI: 2.51-6.01).

CONCLUSION: A significant association existed between frailty and 90-day mortality in the Danish cohort. However, the CFS is a better predictor of 90-day mortality the FP. Even so, the CFS still has a lack of sensitivity and specificity.

FUNDING: none TRIAL REGISTRATION. not relevant.

BACKGROUND: Patients with psoriasis have an impaired quality of life and higher use of analgesics than the general population. Whether such use is due to skin pain or a consequence of joint pain resulting from psoriatic arthritis (PsA) is not clear.

OBJECTIVES: To assess symptoms, disease burden, and use of analgesics in patients with psoriasis with and without PsA.

METHOD: Symptoms, general health (EurQol 5-dimension and 5-levels), and use of analgesics were assessed in patients with psoriasis and the general population from the Danish Skin Cohort.

RESULTS: We included 4016 patients with psoriasis (847 with concomitant PsA) and 3490 reference individuals. For patients with psoriasis having PsA, itch, skin pain, and/or joint pain was associated with worse general health. Use of opioids within 12 months was observed among 9.0% of the general population, 14.2% of patients with psoriasis without PsA, and 22.7% of patients with concomitant PsA. Of the symptoms, only joint pain was associated with use of analgesics (odds ratio, 3.72 (2.69-5.14); P < .0001).

LIMITATIONS: Cross-sectional design.

CONCLUSION: Patients with psoriasis (especially concomitant PsA) have a higher use of analgesics compared with the general population, which appears to be a result of increased joint pain.